Diffuse Esophageal Spasm and Nutcracker
Esophagus
A 34-year-old man complains of “crushing” chest
discomfort for 1 hour. He has no significant medical history. The ECG is normal. He is given
sublingual nitroglycerin in the emergency room
that improves his chest pain almost immediately.
Pathogenesis. Esophageal spastic disorders are idiopathic abnormalities of the neural
processes of the esophagus. Fundamentally,
diffuse esophageal spasm and nutcracker esophagus are the same disease.
The only difference may be in the manometric pattern.
Clinical Presentation. These patients present
with intermittent chest
pain and dysphagia. The pain can simulate that of a myocardial infarction, but it
bears no relationship with exertion. There is no relationship with eating,
ruling out odynophagia. The pain can be precipitated by drinking cold liquids.
Diagnosis. Barium studies may show a “corkscrew”’ pattern
at the
time of
the spasm. The most accurate test is manometric studies, which will
show high-intensity, disorganized contractions. Because the contractions are
disorganized, they do not lead to the forward flow of food and peristalsis.
Treatment is with calcium-channel blockers, such as nifedipine, and nitrates.
0 التعليقات:
Post a Comment